Can I Take HIV Medications While I’m Pregnant?

There seems to be an ever-growing list of things to avoid during pregnancy. Coffee, deli meat, and hot tubs, just to name a few. But when it comes to medications during pregnancy, the answers appear less clear. That’s because pregnant women tend to be excluded from clinical trials used to approve medications. 

If you’re living with HIV, taking HIV medications can help you live a longer, healthier life. But if you’re also pregnant, you may want to know about their potential benefits — and risks — for you and your unborn baby.

Here, we’ll unpack HIV medications and whether or not you should take them during pregnancy. 

What are HIV medications?

HIV medications — also referred to as antiretrovirals — treat and prevent new HIV infections. HIV medications block the virus from making copies of itself and infecting your cells. There are different types — or “drug classes” — of HIV medications. Each class attacks the virus differently.

A typical HIV treatment regimen contains multiple HIV medications from at least two different drug classes. Together, these medications can make the amount of virus in your body so low that it’s undetectable. This means it’s not measurable in lab results.

Treating HIV with HIV medications is referred to as antiretroviral therapy (ART). ART is recommended for everyone with HIV, including those who are pregnant. 

Is it safe to take HIV medications while I’m pregnant?

Generally speaking, taking HIV medications is one of the best things you can do for your health if you’re living with HIV. These medications stop the virus from infecting your immune system cells. This helps your immune system stay strong so it can fight off infections.

Keeping the viral load (amount of virus in your body) low will also prevent other HIV-related complications. And taking HIV medications during pregnancy can reduce the risk of HIV transmission to your unborn baby. 

Are there any risks of taking HIV medications while pregnant?

As with all medications, there are some risks that come with taking HIV medications. And taking them during pregnancy is no exception. Some HIV medications may harm your unborn baby, but the research is limited.

Women of childbearing age are recommended to get 400 mcg of folic acid (vitamin B9) every day. This is to prevent neural tube defects during pregnancy. Although rare, neural tube defects have been reported with the HIV medication, Tivicay (dolutegravir). But it’s not clear if these effects were due to a folic acid deficiency or the medication interfering with folate in the body.

Since the initial reports, more data is available that doesn’t strongly support this concern. Based on the available evidence, experts recommend Tivicay as a first-choice option during pregnancy. 

Should I wait to start HIV medications if I’m not already taking them?

Experts recommend that pregnant women start HIV medications as soon as possible. Doing so can reduce the risk of transmitting HIV to your unborn baby.

That being said, it’s important to make sure that you’re ready to start taking HIV medications. That’s because HIV is a chronic infection that can require daily pills. Taking your HIV medications as prescribed (medication adherence) is important so they’ll remain effective against the virus. Adherence is also important to help keep you and your unborn baby healthy. 

Are there preferred HIV medications to use during pregnancy?

Yes, there are certain HIV medication regimens that are preferred during pregnancy. Yet, the preferred regimen will depend on your situation.

If you’re already well-controlled on your current HIV regimen when you become pregnant, experts recommend that you continue taking these medications. But there are a few exceptions to this rule.

For example, some HIV medications should be avoided during pregnancy for safety reasons. But these are typically older HIV medications that aren’t commonly used in the U.S. anymore.

Other times, pregnancy can cause HIV medication levels to be lower than usual. This happens to one of the HIV medications in Symtuza. For this reason, Symtuza isn’t recommended for HIV treatment during pregnancy.

If you’re pregnant and not currently taking HIV medications, there are first-choice treatment regimens. Here are a few:

• Triumeq

• Tivicay + Truvada or Descovy

• Isentress + Truvada, Descovy, or Epzicom

• Reyataz with Norvir + Truvada, Descovy, or Epzicom

In fact, if you’re thinking about becoming pregnant, have a conversation about family planning with your HIV provider. They might recommend switching to a first-choice treatment option before you become pregnant. 

What can happen if I stop taking HIV medications while pregnant?

The relationship between taking HIV medications and the amount of HIV in your body is a simple formula. Taking HIV medications keeps your viral load low. This prevents HIV from attacking your immune cells, which allows your immune system to stay healthy and fight off infections.

If you stop taking HIV medications, HIV will start making copies of itself and infect new immune cells. This can happen even if you have undetectable amounts of virus in your blood.

Not taking HIV medications during pregnancy can put you at risk for serious infections and other HIV-related complications. And the risk of transmitting HIV to your unborn baby also goes up when these medications are stopped. 

Is it ever OK to stop HIV medications during pregnancy?

There are some cases where your healthcare provider may tell you to stop taking your HIV medications. Such cases may include times when you’re having severe pregnancy-related nausea and vomiting that isn’t responding to medications, or if you’re showing signs of a serious side effect from a medication.

Whatever the case, make sure you stop taking all your HIV medications at the same time. And you should also restart them at the same time, whenever your healthcare provider tells you to.

What about PrEP?

We’ve focused mostly on taking HIV medications for HIV treatment during pregnancy. But you may be wondering about medications for HIV prevention. These medications are referred to as pre-exposure prophylaxis (PrEP). The PrEP option of choice for pregnant women is Truvada.

If you’re already taking Truvada for PrEP, you can continue to take it for HIV prevention if you become pregnant. Unlike HIV medications for treatment, you don’t have to continue PrEP medications your whole pregnancy. Talk to your healthcare provider if you think your risk for acquiring HIV has changed, and you’re not sure if you want to continue PrEP. 

Why trust our experts?

Written by:

Hope Chang, PharmD, AAHIVP

Hope Chang is a freelance writer and content reviewer for GoodRx. She attended Howard University College of Pharmacy in Washington, D.C. and completed post-graduate residency training at the University of California, Davis Medical Center.

Edited by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

Reviewed by:

Christina Aungst, PharmD

Christina Aungst, PharmD, is a pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019, transitioning from freelance writer to editor in 2021.

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